ERIC JEROME ELDRIDGE (NPI# 1902312531) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902312531 |
| Entity Type | Individual |
| Full Name | ERIC JEROME ELDRIDGE |
| Practice Address |
12285 Dixie Ste 100 Redford MI 48239-2491 |
| Practice Telephone | 3135433393 |
| Practice Fax Number | 3135433395 |
| Mailing Telephone | 3135433393 |
| Mailing Fax Number | 3135433395 |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2017-12-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
12285 DIXIE STE 100 |
| City | REDFORD |
| State | MI |
| Zip Code | 48239-2491 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598191884 | Johanna Nicolia-adkins | Social Worker | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2013-09-19 |
| 1457901142 | Gayland Adkins | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2019-09-16 |
| 1730649518 | Paul Donald Hatton | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2019-03-20 |
| 1881158269 | Shirley Ann Cockrell | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2019-01-30 |
| 1881164549 | Wayne Allen Westerlund | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2018-11-26 |
| 1669988234 | Eugene Chester Montagano | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2017-12-19 |
| 1831605328 | Shelley Nelson | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2017-12-19 |
| 1598271421 | Edna Washington | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2017-12-14 |
| 1932615861 | Lee Ann Norris | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2017-12-14 |
| 1881122075 | Stephanie Nobach | Social Worker | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2017-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942849856 | Court'nee Ann Desmond | Nurse Practitioner | 14761 Telegraph Rd, Redford, MI 48239 | 2019-12-26 |
| 1891250239 | Sun Valley Pharmacy LLC | Pharmacy | 9291 Telegraph Rd, Redford, MI 48239 | 2019-02-08 |
| 1003343369 | Lucinda Pryor | Nurse Practitioner | 14210 Marion, Redford, MI 48239 | 2017-05-17 |
| 1740725274 | Georgetta W Bond | Technician, Other | 12770 Hemingway, Redford, MI 48239 | 2016-12-19 |
| 1508318015 | Doris Mckinney | Counselor | Lincoln Behavioral Services - 9315 Telegraph, Redford, MI 48239 | 2016-10-31 |
| 1609282110 | Rosaundra Tanika Pope | Home Health | 9989 Royal Grand, Redford, MI 48239 | 2014-07-03 |
| 1497170179 | Courtney Ritchie | General Practice | 24435 Plymouth Rd, Redford, MI 48239 | 2014-03-04 |
| 1003168592 | Alicia Monique Lurry | Counselor | 8171 Parkland, Detroit, MI 48239 | 2012-10-08 |
| 1407116080 | Ariss Tiffani Pierce | Physical Therapist | 14615 Telegraph Rd Ste 1, Redford, MI 48239 | 2012-05-17 |
| 1205144409 | Steven Thomas Haynes | Counselor | 7411 Parkland, Redford, MI 48239 | 2010-09-22 |
| Find all providers in zip 48239 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831711613 | John Lee Williams Jr. | Peer Specialist | 24400 Schoolcraft, Redford, MI 48239-2633 | 2020-05-14 |
| 1124669775 | Sara Kifah Jayyousi | Peer Specialist | 9315 Telegraph Rd, Redford, MI 48239-1260 | 2019-10-04 |
| 1457901142 | Gayland Adkins | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2019-09-16 |
| 1013562099 | Richard Allan Warner | Peer Specialist | 9315 Telegraph Rd, Redford, MI 48239-1260 | 2019-08-06 |
| 1730649518 | Paul Donald Hatton | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2019-03-20 |
| 1154886968 | Felicia Cooper | Peer Specialist | 9315 Telegraph Rd, Redford, MI 48239-1260 | 2019-02-06 |
| 1881158269 | Shirley Ann Cockrell | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2019-01-30 |
| 1881164549 | Wayne Allen Westerlund | Peer Specialist | 12285 Dixie Ste 100, Redford, MI 48239-2491 | 2018-11-26 |
| 1235625815 | Sarah Alice Smith | Peer Specialist | 24435 Plymouth Rd, Redford, MI 48239-1616 | 2018-07-06 |
| 1851886048 | April Moorer | Peer Specialist | 9315 Telegraph Rd, Redford, MI 48239-1260 | 2018-06-29 |
| Find all providers in REDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.